Identifying ethical stressors in the workplace and giving proper feedback to the authorities to eliminate these factors and improve the ethical climate in these workplaces can help enhance job satisfaction in nurses and lead to higher quality care.

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IntroductionA pressure ulcer is a serious safety issue in healthcare systems. The patient’s rate of infection with an ulcer, especially a postoperative ulcer, is critical, as it is dictated by factors such as being in a fixed position during surgery, the type of anesthesia used, the duration of surgery, and patient-related factors. The present study was conducted to carry out a systematic assessment of the prevalence of a postoperative pressure ulcer and to find its general prevalence using a meta-analysis.MethodsThe researchers searched databases, including PubMed, Google Scholar, Scopus, Science Direct, the Thomson Reuters’ Web of Science (WOS). For English articles published online between January 2000 and October 2015 on the subject of a pressure ulcer, a total of 19 articles were ultimately selected based on the study inclusion criteria. Then results were analyzed in Stata-11.ResultsThe 19 articles qualified for entering the meta-analysis examined a total of 9527 patients. The studies estimated the general prevalence of a postoperative pressure ulcer as 18.96% (CI 95%: 15.3–22.6); the prevalence by gender was reported as 10.1% (CI 95%: 7.2–13.01) in men and 12.8% (CI 95%: 8.3–17.2) in women. Stage 1 ulcer had a 17.02% prevalence (CI 95%: 11.04–22.9), stage 2 a 6.7% prevalence (CI 95%: 3.8–9.7), stage 3 a 0.9% prevalence (CI 95%: 0.2–1.6), and stage 4 a 0.4% (CI 95%: −0.05–0.8) prevalence.ConclusionThe prevalence of a postoperative pressure ulcer is high among the entire population; however, it is still higher in women than in men. The prevalence of a stage 1 ulcer is higher than the prevalence of the other stages of an ulcer.

Background:An appropriate and effective nurse-patient communication is of the most important aspect of caring. The formation and continuation of such a relationship depends on various factors such as the conditions and context of communication and a mutual understanding between the two. A review of the literature shows that little research is carried out on identification of such barriers in hospital wards between the patients and the healthcare staff.Objectives:The present study was therefore conducted to explore the experiences of nurses and patients on communication barriers in hospital cardiac surgery wards.Design and Methods:This qualitative research was carried out using a content analysis method (Graneheim & Lundman, 2004). The participants were selected by a purposeful sampling and consist of 10 nurses and 11 patients from the cardiac surgery wards of three teaching hospitals in Tehran, Iran. Data was gathered by unstructured interviews. All interviews were audio-taped and transcribed verbatim.Results:Findings were emerged in three main themes including job dissatisfaction (with the sub-themes of workload tension and decreased motivation), routine-centered care (with the sub-themes of habitual interventions, routinized and technical interventions, and objective supervision), and distrust in competency of nurses (with the sub-themes of cultural contrast, less responsible nurses, and their apathy towards the patients).Conclusions:Compared to other studies, our findings identified different types of communication barriers depending on the nursing settings. These findings can be used by the ward clinical nursing managers at cardiac surgery wards to improve the quality of nursing care.

The Moral Distress Scale-Revised was found to be a multidimensional construct. The data obtained confirmed the hypothesis of the factor structure model with a latent second-order variable. Since the convergent and divergent validity of the scale were not confirmed in this study, further assessment is necessary in future studies.

Background and Purpose: Ethical climate is hinged upon organizational culture, rules, and policies; nurses' perception of this concept varies according to the ward they are working on and the new rules of the treatment system. This can exert adverse impact on their care method and performance. Thus, this study aimed to determine nurses' perceptions of the ethical climate governing the hospital environment. Methods: This descriptive, cross-sectional study was conducted on 168 nurses working in a teaching hospital. The data were collected through census method, using a demographic form and Olson's Hospital Ethical Climate Survey (HECS). For data analysis, descriptive (percentage, frequency, mean, and standard deviation) and inferential statistics (independent t-test and ANOVA for the establishment of the relationship between ethical climate and demographic factors, as well as Friedman's test for ranking the factor) were used. Results: Mean ethical climate scores of nurses for managers, hospital, physicians, patients, and colleagues factors were 3.87±0.71, 3.39±0.68, 3.00±0.67, 3.68±0.57, and 3.82±0.54, respectively. The total mean score of ethical climate was 3.5±0.51. The comparison among the mentioned factors indicated that managers (P=0.000) factor acquired the highest score. In addition, organizational ethical climate did not show any significant association with gender, marital status, education level, working shift, and employment status, whereas there was a statistically significant relationship between job title and income (P=0.000). Conclusion: The highest score of ethical climate belonged to managers/ factor, while the minimum score was related to physicians. Regarding the role of ethical climate in the improvement of nurses' performance, planning for enhancing the ethical climate seems to be mandatory.

Background:Sleep disorders and depression, accompanied by reduced quality of life and increased mortality are the most common psychological problems in dialysis patients. This study was conducted with the aim to investigate depression and sleep quality and their association with some demographic and clinical factors in hemodialysis patients.Method:This descriptive-correlative study was conducted on 310 patients undergoing hemodialysis in 8 centers in educational hospitals in Mazandaran University of Medical Sciences. Data collection tools included a demographic questionnaire, Beck Depression Inventory, and Pittsburg Sleep Quality Index (PSQI). Statistical analysis was conducted using Chi-Square test and regression model.Results:Results obtained showed 44.8% depression in patients. Significant relationships were found between depression and increased blood phosphorus (P=0.002) and urea (P=0.001). Poor sleep quality was observed in 73.5% of hemodialysis patients, which was found significantly related to aging (P=0.048), female (P=0.04), and reduced frequency of weekly hemodialysis (P=0.035).Conclusion:Depression and poor sleep quality are two common factors in hemodialysis patients, but patients do not overtly show symptoms of these disorders.

The aim of this study was to determine the relationship between quality of life with stress in the haemodialysis patients. This descriptive correlation study was done on 100 haemodialysis patients selected by consent method from Imam Khomeini and Fatemeh Zahra Hospitals in Sari/Iran from March 2008 to February 2009. Data were collected in questionnaire consisting of 3 sections (demographic feature, quality of life and stress) in three months. In the questionnaire, first, quality of life then stress in the patients was studied and the variables described. Then the relation between them was determined by statistical analysis. From the total number of 100 patients (53 men and 47 women) under study, 42% with partial comfortable life had moderate tension. Pearson correlation coefficient showed that there is a significant linear relationship with quality of life and degree of tension, (r = 0.802). That is with increase of tension, quality of life declines (p < 0.001). Also Pearson correlation coefficient indicated that there is positive correlation between the number of hemodialysis per week and the history of dialysis (p = 0.001). History of dialysis in 69% of the patients was 1-5 years and 74% of them were dialyzed in the morning trice a week. Findings showed that, with increase of stress, quality of such patients' life decreases. Therefore, the nurses and the other members of medication team should know to reduce the patient's stress using the supportive procedures and adaptation techniques, help improve quality of life by proper intervention method.